Non–Face-to-Face Chronic Care Management: A Qualitative Study Assessing the Implementation of a New CMS Reimbursement Strategy

Abstract

Diabetes and its comorbidities are leading causes of morbidity and mortality in the United States and disproportionately in Louisiana. Chronic care management (CCM) efforts, such as care coordination models, are important initiatives in mitigating the impact of diabetes, such as poorer health outcomes and increased costs. This study examined one such effort, the Centers for Medicare & Medicaid Services' non-face-to-face CCM reimbursement program, for patients with diabetes and at least 1 other chronic condition in Louisiana. This qualitative study included interviews with patients in this program and health care providers and system leaders implementing the program. Results include lessons learned from health system leadership relating to CCM design and implementation, challenges experienced, overlapping initiatives, perceived benefits, performance, billing, and health information technology. Another key finding is that co-pays seem to be a barrier to patient interest in participation in non-face-to-face CCM, especially given that the value of the program is not completely clear to patients. A common strategy to address this co-pay barrier is to target dual eligibles, as Medicaid will cover the co-pay. However, widespread use of such strategies may indirectly exclude individuals who need and may also benefit from non-face-to-face CCM.

A state‐of‐the‐art review of the experience of care coordination interventions for people living with multimorbidity

“…Two studies were focused on specific cultural populations in Australia, Canada and New Zealand (Askew et al, 2016; Sheridan et al, 2019). Eight articles focused on older adults living with multimorbidity (Brown, Stainer, Stewart, Clacy, & Parker, 2008; Greenfield et al, 2014; Hjelm, Holst, Willman, Bohman, & Kristensson, 2015; Newbould et al, 2012; Scholz Mellum, Martsolf, Glazer, Tobias, & Martsolf, 2018; Sefcik et al, 2018; Spoorenberg et al, 2015; Yeager et al, 2018). Eight articles reported interventions targeting participants deemed to be at high risk of hospital admission (Gowing, Dickinson, Gorman, Robinson, & Duncan, 2016; Grinberg, Hawthorne, LaNoue, Brenner, & Mautner, 2016; Hjelm et al, 2015; Hudon, Chouinard, Diadiou, Lambert, & Bouliane, 2015; Hudon et al, 2018; Mao et al, 2017; Newbould et al, 2012; Walker et al, 2013).…”

“…Similarly, some articles in our review called for more research to ensure generalisability of the findings (Mao et al, 2017; Scholz Mellum et al, 2018; Yeager et al, 2018). We have two concerns about this approach: Qualitative studies are inherently context‐driven (Carminati, 2018; Crabtree & Miller, 1999), and arguably any results open to researcher interpretation are unable to be generalised.…”

Variations in Costs of a Collaborative Care Model for Dementia

“…Based in our study's projected costs, to be adequately compensated by CCM payments, programs would need to maintain a minimum of 50 patients per CTN in regions similar to Nebraska and a higher number in regions similar to California. In addition, CCM does not account for costs associated with staff turnover, adapting electronic medical systems to document non–face‐to‐face care management activities, and multiple providers (only one provider can bill for services in a month) . Finally, the requirement of 24/7 access to providers and the cost sharing required of patients may be significant barriers for some health systems .…”

“…In addition, CCM does not account for costs associated with staff turnover, adapting electronic medical systems to document non-face-to-face care management activities, and multiple providers (only one provider can bill for services in a month). 25 Finally, the requirement of 24/7 access to providers and the cost sharing required of patients may be significant barriers for some health systems. 13 Some have suggested that payments for collaborative dementia programs need to be restructured altogether, by moving away from fee for service toward a per beneficiary monthly payment that would include a comprehensive range of reimbursable services.…”

A Platform and Clinical Model to Enable Medicare's Chronic Care Management Program

“…Despite the positive effects on goal-directed care, utilization, and cost, and positive patient and provider feedback, the CCM program remains grossly underutilized. [4][5][6][7] The primary aim of this study was to develop a technology and integrated clinical staff platform (Chronic Care Management, Inc, Cleveland, OH [CCMI]) to enable a scalable, evidence-based implementation of the Medicare CCM program and to examine factors associated with hospitalization.…”